右美托咪啶抑制阑尾切除术中牵拉反射

摘要

目的 观察右美托咪啶对阑尾切除术中牵拉反射的抑制作用.方法 选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级的急性阑尾炎患者60例,随机分为2组,每组30例.观察组在硬膜外穿刺前静脉输注右美托咪啶1μg·kg-1,继以1μg·kg-1·h-1维持,对照组输注等量生理盐水.观察输注右美托咪啶前(T1)、硬膜外穿刺前(T2)、麻醉平面固定后(T3)、牵拉阑尾时(T4)、缝皮结束时(T5)的血压和心率,牵拉反射、恶心呕吐、寒战、低血压、心动过缓等的发生率.结果 2组在T3、T4、T5时的血压和心率较T1、T2明显下降(P<0.05);观察组T3、T4、T5心率、牵拉反射和寒战的发生率明显下降(P<0.05).结论 右美托咪啶可以抑制硬膜外阻滞下阑尾切除术中的牵拉反射,并预防术中寒战.%Objective To observe the inhibition of stretch reflex by dexmedetomidine in appendectomy. Methods Sixty acute appendicitis' patients with American Society of Anesthesiologists (ASA) physical status I to Ⅱ were randomly divided into two groups. The observation group received 1 μg · kg-1 of dexmedetomidine through intravenous injection before epi-dural puncture,followed by 1 μg · kg-1 · h-1 continuous infusion. The control group received saline with the same volume. Before infusing dexmedetomidine(Tl) ,epidural puncture (T2) , after level of anesthesia was confirmed (T3) ,on stretching the appendix ( T4) and when operation was finished ( T5 ) , respectively. Blood pressure and heart rate were recorded, the incidence of stretch reflex,nausea,vomiting,shivering,hypotension,bradycardia during operation were determined. Results Blood pressure and heart rate were obviously decreased in two groups at T3 ,T4 and T5 than at T1 and T2. Heart rate at T3 ,T4,T5 and the incidence of stretch reflex and shivering were obviously decreased in observation group. Conclusion Dexmedetomidine can inhibit stretch reflex in appendectomy on epidural block and prevent shivering during operation.